Healthcare Provider Details

I. General information

NPI: 1497750673
Provider Name (Legal Business Name): JAY A FLEISCHMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 WATERS PL SUITE M104
BRONX NY
10461-2728
US

IV. Provider business mailing address

1200 WATERS PL SUITE M104
BRONX NY
10461-2728
US

V. Phone/Fax

Practice location:
  • Phone: 914-315-5111
  • Fax: 718-918-0442
Mailing address:
  • Phone: 914-315-5111
  • Fax: 718-918-0442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number175307-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number038615
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: